Download Cognitive Processing Therapy (CPT).

Posttraumatic stress disorder (PTSD) is a severe anxiety disorder that may form in individuals after exposure to trauma. It can have debilitating effects, including flashbacks or nightmares, avoidance of associated stimuli, hyperarousal, or sleep disturbances. Of these, sleep disturbances can cause the most damage, eventually manifesting into insomnia, which reduces daytime functioning and can further lead to other health complications. Benzodiazepines are prescribed to lessen sleep disturbances, but they also depress the central nervous system, thereby decreasing cerebral blood flow and REM sleep, both of which help with learning and memory consolidation. This then may challenge the outcome of cognitive
Benzodiazepines and their Effects on
Cognitive-Behavioral Therapy
David A. Reichenberger, Department of Psychology, College of Arts and Sciences, & Honors College
Daniel J. Taylor, Ph.D., Department of Psychology
Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD) is a severe anxiety
disorder that may form in individuals after exposure to
trauma. It can have debilitating effects, including
flashbacks or nightmares, avoidance of associated stimuli,
hyperarousal, or sleep disturbances (American Psychiatric
Association [APA], 1994). Approximately 70% of
individuals with PTSD suffer from sleep impairment
(Ohayon & Shapiro, 2000). Such sleep impairment
includes increases in sleep onset latency, lower sleep
efficiency, and decreased total sleep time (Babson &
Feldner, 2010; Yetkin, Aydin, & Özgen, 2010). These can
severely affect daytime functioning. Most individuals are
prescribed benzodiazepines to alleviate symptoms.
Apparatus
Clinician-Administered PTSD Scale (CAPS). Participants were given the
Clinician-Administered PTSD Scale (Blake et al., 1998). CAPS incorporates
frequency and intensity scales that remain consistent with diagnoses of PTSD in
the DSM-IV, so its use will determines whether or not an individual is eligible to
participate in the study.
Pittsburgh Sleep Quality Index (PSQI). The Pittsburgh Sleep Quality Index
(Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) is a self-report measure of
the sleep quality and disturbances of an individual. It demonstrates subjective
sleep quality, sleep onset latency, total sleep time, sleep efficiency, the number of
nighttime disturbances, sleep aids, and daytime dysfunction. Baseline differences
in sleep medication use and/or changes in medications over time were determined
using the PSQI.
PTSD Symptom Scale (PSS). A 17-item scale (Foa, Riggs, Dancu, & Rothbaum,
1993) that represents criteria for PTSD
Hypothesis
It is hypothesized that benzodiazepines inversely affect
the outcomes of cognitive-processing therapy and
prolonged exposure.
Participants were randomly assigned to one of three treatment
groups that included cognitive-processing therapy (CPT),
prolonged exposure (PE), and a minimal attention (MA)
condition (Resick et al., 2002). Treatments continued for six
weeks, and then those in MA were randomly assigned to either
CPT or PE. Treatments were conducted twice each week for a
total of 13 hours of treatment. A follow-up was completed for
each participant after 3 months.
Data Analysis
Data will be analyzed using correlations to determine if there
are any statistically significant associations between the type
and/or amount of benzodiazepines used and the individuals’
respective PTSD scores.
Cognitive-Behavioral Therapy
• Cognitive Processing Therapy (CPT).
Individuals undergoing CPT (Resick & Schnicke,
1993) learn to identify the relationships among the
events, thoughts, and emotions associated with the
trauma(s), and then their beliefs of the trauma are
challenged with questions regarding their
perceptions.
• Prolonged Exposure (PE). Individuals who
undergo PE (Foa, Hearst, Dancu, Hembree, &
Jaycox, 1994) are educated about PTSD. They also
engage in behavioral exposure to reduce avoidance
and negative emotional responses.
Method
References
Participants
The study will include approximately 108 females with PTSD, all of whom are
victims of sexual assault. The sample is derived from a larger study by Resick,
Nishith, Weaver, Astin, and Feuer (2002). Participants were 3 months post-trauma,
stabilized on medication, and did not meet exclusion criteria, which included
current psychosis, severe suicidality, dependence on drugs or alcohol, and illiteracy.
They could not currently be in an abusive relationship or being stalked. In the case
of marital rape, the participant must have been out of the relationship for at least 6
months. All participants met the criteria for PTSD as measured by the ClinicianAdministered PTSD Scale (Blake et al., 1998). Demographic and clinical
characteristics of the women are currently unknown, though most were white and
single.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental
Disorders (4th edition). Washington, DC: Author. Babson, K. A., & Feldner, M. T.
(2010). Temporal relations between sleep problems and both traumatic event exposure
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Psychiatry, 41, 469-478.
Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of
cognitive-processing therapy with prolonged exposure and a waiting condition for the
treatment of chronic posttraumatic stress disorder in female rape victims. Journal of
Consulting and Clinical Psychology, 70, 867-879. doi: 10.1037/0022-006X.70.4.867
Resick, P. A. & Schnicke, M. K. (1993). Cognitive processing therapy for rape victims: A
treatment manual. Newbury Park, CA: Sage.
Yetkin, S., Aydin, H., & Özgen, F. (2010). Polysomnography in patients with post-traumatic
stress disorder. Psychiatry and Clinical Neurosciences, 64, 309-317. doi:
10.1111/j.1440-1819.2010.02084.x